Obsessive-compulsive personality disorder
| }} Obsessive-compulsive personality disorder (OCPD), or anankastic personality disorder, is a personality disorder that is characterized by a general psychological inflexibility, rigid conformity to rules and procedures, perfectionism, moral code, and/or excessive orderliness. Obsessive-compulsive personality disorder (OCPD) is often confused with obsessive-compulsive disorder (OCD). OCD is ego-dystonic where OCPD is ego-syntonic. This is to say, those with OCD know their behavior is problematic where the symptoms of OCPD are part of a person's personality and are generally unaware of problematic behaviors. Those who are suffering from OCPD do not generally feel the need to repeatedly perform ritualistic actions (such as excessive hand-washing), while this is a common symptom of OCD. Instead, people with OCPD tend to stress perfectionism above all else, and feel anxious when they perceive that things are not "right." People with OCPD may hoard money for future use, keep their home perfectly organized, or be anxious about delegating tasks for fear that they won't be completed correctly. There are four primary areas that cause anxiety for OCPD personalities: time, relationship, dirt (uncleanliness) and money. There are few moral gray areas for a person with OCPD; actions and beliefs are either completely right, or absolutely wrong. As might be expected, interpersonal relationships are difficult because of the excessive demands placed on friends, romantic partners, and children. Diagnostic criteria (DSM-IV-TR) The DSM-IV-TR, a widely used manual for diagnosing mental disorders, defines that for a patient to be diagnosed with obsessive-compulsive personality disorder, they must exhibit at least four of the following traits: * Preoccupation with details, rules, lists, order, organization, bodily functions, or schedules to the extent that the major point of the activity is lost * Showing perfectionism that interferes with task completion (e.g., is unable to complete a project because his or her own overly strict standards are not met) * Excessive devotion to work and productivity to the exclusion of leisure activities and friendships (not accounted for by obvious economic necessity) * Being overconscientious, scrupulous, and inflexible about matters of morality, ethics, or values (not accounted for by cultural or religious identification) * Inability to discard worn-out or worthless objects even when they have no sentimental value * Reluctance to delegate tasks or to work with others unless they submit to exactly his or her way of doing things * Adopting a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes * Showing rigidity and stubbornness * Urge to perfect every little thing It is important to note that while a person may exhibit any or all of the characteristics of a personality disorder, it is not diagnosed as a disorder unless the person has trouble leading a normal life due to these issues. Mnemonic A mnemonic that can be used to remember the criteria for obsessive-compulsive personality disorder is LAW FIRMS. * L''' – Loses point of activity (due to preoccupation with detail) * '''A – Ability to complete tasks (compromised by perfectionism) * W''' – Worthless objects (unable to discard) * '''F – Friendships (and leisure activities) excluded (due to a preoccupation with work) * I''' – Inflexible, overconscientious (on ethics, values, or morality, not accounted for by religion or culture) * '''R – Reluctant to delegate (unless others submit to exact guidelines) * M''' – Miserly (toward self and others) * '''S – Stubbornness (and rigidity) History Sigmund Freud first characterized what is now known as obsessive-compulsive or anankastic personality disorder as the anal character. This fixation fit into his theory of psychosexual development. Treatment Treatment for OCPD normally involves psychotherapy and self help. Medication is generally not indicated for this personality disorder in isolation, but Prozac has been prescribed with success. Anti-anxiety medication will reduce the feeling of fear and SSRI's can replace the chronic frustration with a sense of well-being, as well as reducing stubbornness and negative rumination. A mild tranquilizer can reduce alcohol dependence, if present. ADD medication can improve task completion by improving mental focus, which will provide visible success and improve outlook for recovery. Caffeine allergy may be an exacerbating factor. Keep in mind, though, that most people with OCPD will try to deny that anything is mentally wrong with them, so they usually won't ever buy into getting any psychological or medical treatment for the whole irrational mental state, and always while living in denial about it being a mental problem will choose to live without therapy and continue to suffer with it, and let it overpower them. Psychotherapy *'Behavior therapy' — Talking with a psychotherapist about ways to change compulsions into healthier, productive actions. *'Psychotherapy' — Talking with a trained counselor or psychotherapist who understands the condition. *'Pharmacotherapy' - will require an appointment with a psychiatrist who can prescribe medications which can make self-management and participation in other therapies possible and productive. Medication All drugs can be grouped together by how they work (i.e., their specific mode of action). Approved drugs include: *'Monoamine oxidase inhibitors' (MAOIs) — Increases levels of the neurotransmitters known to influence behavioral patterns in the brain, such as serotonin. This helps control the obsessions and compulsions. *'Selective serotonin reuptake inhibitors' (SSRIs) — Increases levels of serotonin in the brain, known to influence the obsessions and compulsions. *Other drugs such anxiolytics are useful for treating the symptoms of anxiety commonly associated with OCPD. Other treatments *'Electroconvulsive Therapy' — Involves the administration of brief electrical impulses to the head while under general anesthesia, which may help to reduce obsessive and compulsive behavior (for the severely ill). *'Neurosurgery' — In special cases, surgery on the specific part of the brain that is involved with OCPD may help to alleviate the obsessions and compulsions (for severe, intractable OCPD). Self help *Educating family and friends about the condition will help them to manage behavioral problems more sympathetically, and to watch out for the warning signs. *Support groups may also be helpful in accepting and changing Obsessive-Compulsive behaviors. *Relaxation, meditation, physical exercise, regular sleep, and a balanced diet are all important factors in maintaining this focus. *Consult your healthcare provider if you are having difficulty sleeping and/or you are experiencing problems that prevent you from taking regular exercise. *Keeping a diary may help the individual to identify those stressful situations that help to trigger compulsive reactions, enabling them to focus on more constructive activities. *Retained items, the result of hoarding, should be released, simultaneously reducing the shame associated with hoarding. Hiring an assistant to cull hoarded, collected, and stored items will facilitate the process, just as a therapist facilitates the work of releasing psychological baggage. Anankastic PD: History of the disorder *historical sources *famous clinicans Obsessive-compulsive PD: Epidemiology *Obsessive-compulsive PD: Incidence *Obsessive-compulsive PD: Prevalence *Obsessive-compulsive PD: Morbidity *Obsessive-compulsive PD: Mortality *Obsessive-compulsive PD: Racial distribution *Obsessive-compulsive PD: Age distribution *Obsessive-compulsive PD: Sex distribution Obsessive-compulsive PD: Risk factors *Obsessive-compulsive PD: Known evidence of risk factors *Obsessive-compulsive PD: Theories of possible risk factors Obsessive-compulsive PD: Etiology *Obsessive-compulsive PD: Known evidence of causes *Obsessive-compulsive PD: Theories of possible causes Obsessive-compulsive PD: Diagnosis & evaluation *Obsessive-compulsive PD: Psychological tests *Obsessive-compulsive PD: Assessment isssues *Obsessive-compulsive PD: Evaluation protocols Obsessive-compulsive PD: Treatment *Obsessive-compulsive PD: Outcome studies *Obsessive-compulsive PD: Treatment protocols *Obsessive-compulsive PD: Treatment considerations *Obsessive-compulsive PD: Evidenced based treatment *Obsessive-compulsive PD: Theory based treatment *Obsessive-compulsive PD: Team working considerations *Obsessive-compulsive PD: Followup Anankastic PD: For people with this difficulty *Obsessive-compulsive PD: Service user: How to get help *Obsessive-compulsive PD: Service user: Self help materials *Obsessive-compulsive PD: Service user: Useful reading *Obsessive-compulsive PD: Service user: Useful websites *Obsessive-compulsive PD: Service user: User feedback on treatment of this condition Obsessive-compulsive PD: For their carers *Obsessive-compulsive PD: Carer: How to get help *Obsessive-compulsive PD: Carer: Useful reading *Obsessive-compulsive PD: Carer: Useful websites Instructions_for_archiving_academic_and_professional_materials Obsessive-compulsive PD: Academic support materials *Obsessive-compulsive PD: Academic: Lecture slides *Obsessive-compulsive PD: Academic: Lecture notes *Obsessive-compulsive PD: Academic: Lecture handouts *Obsessive-compulsive PD: Academic: Multimedia materials *Obsessive-compulsive PD: Academic: Other academic support materials *Obsessive-compulsive PD: Academic: Anonymous fictional case studies for training Obsessive-compulsive PD: Anonymous fictional case studies for training See also * Anal retentive * Compulsions * Compulsive repetition * Obsessions * Obsessive-compulsive disorder References * Salzman, Leon. 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External links * [http://www.ocdonline.com/articlephillipson6.php Obsessive-compulsive personality disorder: A Defect of Philosophy, not Anxiety] Article about the characteristics of OCPD by Steven Phillipson * [http://groups.msn.com/OCPD OCPD support group] Online support group for those with OCPD and their loved ones. Message board, links, and bibliography. Category:Personality disorders Category:Obsessive-compulsive PD